exam 5 watts alcohol

Question 1

where is alcohol absorbed?

Answer 1

10% in stomach and the rest in intestine
limited by gastric emptying
increases acid release

Question 2

what is the distribution of alcohol?

Answer 2

distributed in TBW
58% in men
48% in women

Question 3

What kinetics does alcohol follow?

Answer 3

Alcohol follows a zero order PK
ADH is the rate limiting step

Question 4

how is alcohol metabolized?

Answer 4

90% in liver
ADH, MEOS involving CYP2E1, ALDH
gluronidation

Question 5

what is ADH?

Answer 5

alcohol dehydrogenase
enzyme in liver and brain
men have higher levels

Question 6

what is fomepizole?

Answer 6

ADH inhibitor used to treat alcohol poisoning
slows fomation of formaldehyde and toxic metabolites so liver has more time to metabolize

Question 7

what is ALDH?

Answer 7

aldehyde dehydrogenase
ALDH1B1 and ALDH2 are important in metabolism of alcohol
SNP ALDH2*2 reduces activity

Question 8

what are heterozygous and homozygous ALDH2*2?

Answer 8

heterozygous can drink
homozygous cannot drink

Question 9

what is disulfrim?

Answer 9

irreversible inhibitor of ALDH
used to treat alcoholism
makes bad symptoms when taking alcohol
effects last up to 14 days

Question 10

What the channels involved in alcohol action?

Answer 10

ligand-gated ion channels:
GABA-a receptors (allosteric activator of inhibitory neurotransmitters)
NMDA receptors
alpha7 nicotinic receptors

Question 11

what neurotransmitters are released with alcohol use?

Answer 11

opioid (enkephalins)
DA
S
NE
ACh
increases CNS and blood ACTH

Question 12

what is the legal driving limit BAC?

Answer 12

0.08 BAC or 80mg%
0.1 BAC is 100mg/dl

Question 13

What are actions at low levels of alcohol?

Answer 13

Euphoria, dishibition, talkative: 30-80mg/dL
Analgesia (60-90mg/dL)

Question 14

What are actions at intermediate levels of alcohol?

Answer 14

CNS stimulation (mood swings + depression): 80-120mg/dl
CNS depression: 100-200mg/dl
Slurred speech, ataxia, sedation, loss of motor control

Question 15

what are pharmacological effects of alochol at high concentrations?

Answer 15

300-500mg/dl
coma
death

Question 16

what the the CV effects of acute alcohol use?

Answer 16

Vasodilation, warm, flush, decreased BP, increased HR

Question 17

what the the CV effects of moderate alcohol use?

Answer 17

risk of CAD
can increase HDL

Question 18

what the CV effects of chornic alcohol use?

Answer 18

Heart problems: arrhythmias, HTN, hemostasis

Question 19

what are physiological effects of alcohol consumption?

Answer 19

Thermoregulation: Hypothermia
GI: increased acid secretion, chronic gastritis

Question 20

what are the long term ADRs of alcohol consumption?

Answer 20

liver: increased fat metabolism, fatty liver leading to cirrhosis, vitamin deficiencies
blood: mild anemia, gastritis, alcohol folic acid deficiency
cancer: liver

Question 21

what are some drug interactions of alcohol?

Answer 21

Cns depressants: opioid, atipsychotics, antihistamines, sedative hypnotics
ALDH inhibitors: disulfiram, antimicrobials, sulfonylureas
APAP
aspirin

Question 22

how do you manage acute intoxication?

Answer 22

prevent respiratory depression
prevent aspiration of vomit

Question 23

how is alcohol teratogenic?

Answer 23

fetal alcohol syndrome
lowers testosterone and sperm quality

Question 24

what are the treatments to alcoholism?

Answer 24

disulfiram: ALDH inhibitor that cause bad reaction to alcohol
camprosate: NMDA antagonist and GABA agonist
naltrexone: opioid receptor antagonist to prevent relapse

Question 25

pts with 118G respond better to what drug?

Answer 25

naltrexone

Question 26

what are off label drugs used to treat alcoholism?

Answer 26

topiramate: inhibits glutamate
baclofen: stimulates GABA
varenicline: nicotinic acetylcholine receptor partial agonist